Conservative management of severe preeclampsia remote from term

Traditionally, preeclamptic women who meet established criteria for severe disease are delivered expeditiously. Although delivery is always appropriate therapy for the mother, it may not be for the fetus remote from term. Two recent randomized clinical trials have demonstrated favorable neonatal outcomes after conservative management of severe preeclampsia remote from term. Nevertheless, because such management entails risk for both the mother and fetus, patients must be selected carefully. We consider women who have severe disease—by ACOG criteria for blood pressure (systolic persistently at least 160 mmHg or diastolic persistently at least 110 mmHg) or proteinuria (5 g/day or greater)—to be candidates for conservative management with close maternal and fetal surveillance. As long as maternal blood pressure can be controlled pharmacologically, maternal laboratory values are stable, and fetal biophysical profiles are normal, we manage these patients conservatively up to 34 weeks’ gestation. Using these guidelines at our institution, we found that approximately two-thirds of patients with severe preeclampsia before 34 weeks were eligible for conservative management. We recommend that such management be performed only at tertiary perinatal centers.